Hội Tim mạch học Việt Nam CRT bao cao

Heart Failure HF Definition A complex clinical syndrome in which the heart is incapable of maintaining a cardiac output adequate to accommodate metabolic requirements and the venous re

Heart Failure (HF) Definition

A complex clinical syndrome in which the heart is incapable of maintaining a cardiac output adequate to accommodate

metabolic requirements and the venous

return.

New York Heart Association Functional Classification

Class I: No symptoms with ordinary activity

Class II: Slight limitation of physical activity Comfortable at rest,

but ordinary physical activity results in fatigue, palpitation, dyspnea, or angina

Class III: Marked limitation of physical activity Comfortable at

rest, but less than ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain

Class IV: Unable to carry out any physical activity without

discomfort Symptoms of cardiac insufficiency may be present even at rest

HF Classification: Evolution and

Disease Progression

• Four Stages of HF (ACC/AHA Guidelines):

Stage A: Patient at high risk for developing HF with no structural disorder of the heart

Stage B: Patient with structural disorder without symptoms of HF

Stage C: Patient with past or current symptoms of HF associated with underlying structural heart disease

Stage D: Patient with end-stage disease who requires specialized treatment strategies

Hunt, SA, et al ACC/AHA Guidelines for the Evaluation and Management of

Chronic Heart Failure in the Adult, 2001

`

MUSTIC: CRT vs no pacing, 58 bn

1 NYHA III, EF<35%, EDD>60mm, 6-min walk<450m,

nhập viện do suy tim

1 To evaluate the effect of CRT for the treatment of

2 To study the applicability of this method for the clinical practice in Vietnam

objectives

MATERIALS AND METHOD

Controlled Trials Inclusion Criteria

Major Cardiac Veins

Position of electrodes

RV pacing LV pacing Biventricular

Follow-up of Cardiac ECHO

Follow-up of ECG and NYHA

QRS width versus benefit (Kass)

Mối liên quan giữa độ rộng QRS và tỷ lệ tử vong

>220

Nghiên cứu VEST:

-Bệnh nhân suy tim NYHA II-IV.

-3654 ĐTĐ được phân tích số hoá

- Tuổi, creatine, LVEF, nhịp tim và

Giá trị tiên lượng của hình ảnh blốc nhánh

Cleveland Clinical

Foundation

Am J Med 2001;110:253

Đáp ứng với CRT: so sánh blốc nhánh phải và blốc nhánh trái

Nghiên cứu Bệnh viện đại học Pittsburgh từ

2000-2007

• Blốc nhánh trái được đặt CRT: 412 bn

• Blốc nhánh phải được đặt CRT: 162 bn

0 10 20 30 40 50 60

Am J Cardiol 2009;103:238

Fluoroscopy time (minutes)

Cosuming time(minutes)

Consuming time and fluoroscopy time in procedures

Adverse Events (Care-HF NEJM 2005)

• Blood test: Normal (Creatinin: 110 mcmol/L)

• Chest X-ray: large cardiac silhouette.

• ECG: sinus rhythm, LBBB, left axis, QRS: 200ms

• Echocardiography: Dd: 64.5 mm, Ds: 55 mm,

EF:30%(T) and 28% (S), mild MR, no thrombus in LA

• Coronary angiograhy: nornal

• After CRT: + NYHA 1.

+ Echocardiography: Dd:62mm,Ds:48mm EF:44%(T), 40% (S).

ECG before CRT

RAO LAO

ECG after CRT

CRT for heart failure with QRS > 150 ms:

- Reduced progression of heart failure

- Reduced ventricular dimension and improved LV systolicfunction

THANK YOU FOR YOUR ATTENTION